Spotlight on psychological impacts

Managing diabetes can negatively impact quality of life for people with the disease, so doctors should consider a patient's treatment burden and the “whole person” when setting goals, 2 studies suggest.

In the first study, researchers used a Markov simulation model to estimate the effects of lowering HbA1c on diabetes outcomes (microvascular and cardiovascular complications) and on overall quality-adjusted life-years (QALYs) in simulated adult patients with type 2 diabetes. They found that in patients with a low treatment burden (0.4 day lost per year) whose medication lowered HbA1c by 1 percentage point, the benefit ranged from 0.08 to 0.10 QALY for those diagnosed at age 75 to 0.77 to 0.91 QALY for those diagnosed at age 45. For those age 75 years, a higher treatment burden (3.7 days lost per year) resulted in more harm than benefit when HbA1c levels were lowered. Across all ages, patients who saw treatment as more burdensome had a net loss in QALYs from HbA1c-lowering treatment.

In summary, the researchers found that once moderate control of HbA1c (9%) was reached, the most important factor that determined benefit from glucose-lowering treatment was a patient's view of treatment burden. As such, physicians should consider the individual burdens and benefits of treatment for each patient, rather than just considering HbA1c targets, the researchers wrote. Their results were published online June 30 by JAMA Internal Medicine.

A second study aimed to capture the most prevalent attitudes and coping strategies of adult patients with diabetes in 17 countries. Following up on previous quantitative work, researchers sought qualitative descriptions of experiences. They issued surveys to 8,596 adults (1,368 with type 1 diabetes and 7,228 with type 2), with open-ended questions about successes, challenges, wishes for improvement, and impactful experiences related to living with diabetes. The researchers found 2 main themes regarding negative experiences: 1) anxiety/fear, worry about hypoglycemia and complications, depression, and negative moods, and 2) discrimination at work and public misunderstanding about diabetes.

The researchers also found 2 themes for adaptive coping of persons with diabetes: having a positive outlook and sense of resilience, and being supported by friends, family, health care workers, and others with diabetes. Such personal accounts “can help to increase understanding of the meaning of diabetes for health care professionals in caring for the whole person,” the researchers wrote. The study was published online June 27 by Diabetes Care.